Reconstructing constructivism: Moving away from the commitment to the social to the study of associations

In this paper, I draw upon two theoretical approaches that have often been placed under the umbrella of ‘social constructivism’. By this I refer to Social Construction of Technology (SCOT) and Actor-Network Theory (ANT). In spite of the various similarities that the two approaches share, there are essential and critical differences between the two positions; differences which I argue have often been conflated and neglected. My intention is therefore to shed light on these differences and to acknowledge their implications. To illustrate this, I will follow an experiment according to which I will apply each of the approaches to my empirical case study, and analyze accordingly the implementation of the Electronic Medical Record (EMR) in the Primary Health Care (PHC) sector. I argue that drawing upon a social constructivist approach overemphasizes the social interest and leads to portraying the EMR as a passive stand-alone tool that is activated and shaped by the various relevant social groups. This leads to the misleading assumptions that the EMR can be mechanically controlled by humans, and can easily be replaced. Moreover, such research also employs a distinction between technology and social issues, and refers to the ‘fit’ between the two as the recipe of a successful implementation of technology. However, the case study of the EMR provides a more complex and ‘fluid’ realm where both the technology and the work-practices are continuously evolving. Drawing upon ANT, the EMR is viewed as part of complex, interconnected sociotechnical networks, which consist of both human and non-human actors. Using a constructivist lens, the technical and the social are irreducible and deeply intertwined, and the focus is on the links that glue the two realms together.